Provider Demographics
NPI:1912421124
Name:JORGE, LISNET (MSN, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISNET
Middle Name:
Last Name:JORGE
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3100
Mailing Address - Country:US
Mailing Address - Phone:520-900-3667
Mailing Address - Fax:
Practice Address - Street 1:5422 S 12TH AVE STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-3297
Practice Address - Country:US
Practice Address - Phone:520-900-3667
Practice Address - Fax:520-337-3343
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10602363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9327106OtherSTATE LICENSE